Worksheetsortho3
Total questions: 90
Worksheet time: 56mins
A 42-year-old lady complains of nocturnal pain over the thumb, index finger and middle finger. Which of the following tests is required to reach a diagnosis?
Cozen's test
Finkelstein test
Phalen's test
Eichhoff test
A 39-year-old male presents with clawing of the ring and little fingers following a deep cut near the medial aspect of the wrist. He has difficulty gripping objects. Which of the following splints would be most appropriate in this case?
A) Cock-up splint
B) Opponens splint
C) Knuckle-bender splint
D) Foot-drop splint
A 45-year-old woman who recently underwent a left mastectomy and axillary dissection for breast cancer now presents to her physician with a chief complaint that she feels like her shoulder blade sticks out sometimes. She denies any pain. This patient’s injured nerve originates at which spinal levels?
A) C1 to C5
B) C5, C6 and C7
C) C5 and C6
D) C7 and C8
A child sustains a supracondylar fracture of the humerus. On examination, there is extension at MCP joints and flexion at IP joints (claw hand), with sensory loss along the medial aspect of the hand and forearm. Which root levels are most likely affected?
C5-C6
C5-C7
C8-T1
C6-C8
A 28-year-old man falls asleep in a drunken state with his arm draped over the back of a chair. He wakes up unable to extend his wrist or fingers. Examination shows wrist drop and intact sensation. What is the most likely classification of nerve injury in this case?
A) Division of nerve fibres
B) Division of axons
C) Division of nerve sheath
D) Physiological block
A 32-year-old factory worker presents with numbness and tingling along the medial side of his hand, especially involving the little finger and medial half of the ring finger. On examination, there is a sensory loss and wasting of hypothenar eminence . This distribution most likely corresponds to which dermatome?
c6 dermatome
c7 dermatome
c8 dermatome
t1 dermatome
A 40-year-old male with Hansen’s disease presents with clumsiness while performing fine motor tasks like buttoning his shirt. Examination reveals wasting of the hypothenar eminence and ulnar claw hand. The clumsiness is most likely due to palsy of which of the following muscles?
A) Extensor carpi ulnaris
B) Abductor pollicis brevis
C) Opponens pollicis
D) Interosseous muscles
A patient develops a complete wrist drop following a midshaft fracture of the humerus. There is the inability to extend the wrist and fingers at the metacarpophalangeal joints. Sensory loss is noted over the dorsum of the hand. Which of the following best describes the likely cause?
low radial nerve palsy
posterior interosseous nerve palsy
high radial nerve palsy
avulsion of triceps tendon
A 35-year-old man with an ulnar nerve injury is noted to have more prominent clawing in a distal (low) lesion compared to a proximal (high) lesion. What is this paradoxical phenomenon due to?
A) Flexor digitorum profundus
B) Flexor pollicis longus
C) Extensor carpi radialis brevis
D) A simultaneous radial nerve disease
A True statement about nerve injury is
A) NCV is the best predictor of outcome within 48 hrs of injury
B) Positive Tinel’s sign, if present, indicates the accurate location of injury
C) Traction nerve injuries are an indication for emergency surgery
D) In all cases of open wounds with clinical signs of nerve injury, nerve exploration must be done
A True statement about nerve injury is
A) NCV is the best predictor of outcome within 48 hrs of injury
B) Positive Tinel’s sign, if present, indicates the accurate location of injury
C) Traction nerve injuries are an indication for emergency surgery
D) In all cases of open wounds with clinical signs of nerve injury, nerve exploration must be done
A 35-year-old male sustains a Sunderland type III Axillary nerve injury. What will his nerve injury be classified as under Seddon’s classification system?
A) Neuropraxia
B) Axonotmesis
C) Neurotmesis
D) None of the above
A 30-year-old male suffers a deep laceration to the posterior thigh with complete transection of the sciatic nerve. After debridement and failed primary repair due to tissue loss, a nerve graft is planned. Which of the following is the most commonly used nerve graft in such cases?
A) Intercostal nerve
B) Saphenous nerve
C) Superficial radial N
D) Sural nerve
A 24-year-old male presents with numbness over the lateral aspect of his upper arm following an anterior shoulder dislocation. Which nerve injury is most likely responsible for this sensory loss, described as the “regimental badge” sign?
A) Radial nerve
B) Ulnar nerve
C) Axillary nerve
D) Musculocutaneous nerve
A 30-year-old male presents with anterior shoulder dislocation after a fall. On examination, he has sensory loss over the upper lateral aspect of the arm. Which of the following muscles is most likely paralyzed in this case?
A) Supraspinatus
B) Infraspinatus
C) Teres major
D) Teres minor
A 35-year-old man presents with weakness in his pinch grip and difficulty holding small objects after receiving a recent vaccination. He is unable to make an ‘OK’ sign with his thumb and index finger. Which nerve is injured, and which muscle is involved?
A) Anterior interosseous nerve – Flexor pollicis longus
B) Posterior interosseous nerve – Extensor pollicis brevis
C) Ulnar nerve – Adductor pollicis
D) Common peroneal nerve – Tibialis anterior
A doctor performs the ‘card test’ by placing a card between the patient’s fingers and asking them to hold it while she tries to pull it away. Which of the following muscle–nerve pairs is being tested?
A) Palmar interossei – Median nerve
B) Dorsal interossei – Median nerve
C) Palmar interossei – Ulnar nerve
D) Dorsal interossei – Ulnar nerve
A 42-year-old office worker presents with gradual onset of weak grip strength and numbness over the thumb, index, and middle fingers. On examination, Durkan’s test is positive. What is the most likely diagnosis?
A) Brachial plexus neuritis
B) Anterior interosseous nerve injury
C) Carpal tunnel syndrome
D) Median nerve transection
A 45-year-old typist presents with numbness and tingling in the thumb, index, middle, and lateral half of the ring fingers, especially at night. She also reports difficulty holding objects and frequent dropping of items. On clinical examination, Tinel’s sign and Durkan test are positive. Which of the following is NOT a feature of this condition?
A) Paresthesia of lateral 3 ½ fingers and palm
B) Positive Tinel’s sign
C) Shake sign
D) Durkan test positivity
A 42-year-old man complains of burning pain and tingling over the sole of his foot, worse at night and after prolonged standing. He gets transient relief by stamping his foot on the ground. On examination, Tinel’s sign is positive behind the medial malleolus. What is the most likely diagnosis?
A) Peripheral vascular disease
B) Tarsal Tunnel syndrome
C) Plantar fasciitis
D) Plantar fibromatosis
A 40-year-old man presents with buttock pain radiating down the posterior thigh, aggravated by sitting and relieved by lying down. There is no spinal tenderness. Which nerve is most likely compressed in this condition?
A) Common peroneal nerve
B) Tibial nerve
C) Sciatic nerve
D) Lateral plantar nerve
A 35-year-old male presents with pain radiating from the neck to the right upper limb along with paresthesia. On examination, the radial pulse diminishes when the patient turns his head to the affected side and takes a deep breath. What is the name of the test, and the most probable diagnosis?
Phalen's test -Carpal Tunnel Syndrome
Allen's test -Raynaud's phenomenon
Adson's test -Thoracic outlet syndrome
Spurling's test -Cervical spondylosis
Which is not a part of Horner's syndrome
ptosis
loss of ciliospinal reflex
exophthalmos
miosis
Consider the following statements related to peripheral nerve injuries: 1. Tinel’s sign is progressive in neuroma-in-continuity and non-progressive in end-neuroma. 2. High (proximal) nerve injuries result in greater deformity and disability compared to low (distal) injuries. 3. Motor march refers to sequential return of muscle power from proximal to distal muscles during recovery 4.In Neurotmesis,there is neuroma in continuity with progressive Tinel's sign 5.According to Sunderland's classification,type 3 nerve injury is axonotmesis
1 statement is correct
2 statements are correct
3 statements are correct
4 statements are correct
Mark the incorrect statement for axillary nerve injury
Root value is C5, c6
Most commonly nerve injured in shoulder dislocation
Deformity-Adduction and internal rotation
Sensory loss over lateral aspect of upper part of forearm
A 32-year-old computer programmer presents with difficulty holding a pen and frequently dropping objects. Examination reveals wasting of the thenar eminence and sensory loss over the lateral 3½ fingers. Palmar sensation is intact. Tinel’s sign is positive.Muscle affected
A) Adductor pollicis
B) Flexor pollicis longus
C) Abductor pollicis brevis
D) Flexor digitorum profundus (ring & little
The figure shows cross section of a nerve.Which of the following represents itemD
epineurium
perineurium
myelin sheath
endoneurium
Carpal Tunnel Syndrome is caused by all except
hypothyroidism
tuberculosis
pregnancy
acromegaly
Guyon's canal is the site of entrapment neuropathy of which of the following nerves
ulnar nerve
median nerve
radial nerve
axillary nerve
Cheiralgia paraesthetica is a compression neuropathy of which nerve
posterior interosseous nerve
superficial radial nerve
sural nerve
lateral cutaneous nerve of forearm
The spina ventosa is seen in:
A) Carpals
B) Phalanges
C) Dorsal spine
D) Shoulder joint
Caries sicca is seen in
hip
spine
shoulder
knee
A 32-year-old male presents with chronic back pain, low-grade fever and constitutional symptoms. MRI of the thoracolumbar spine reveals vertebral body destruction and paravertebral abscess formation. In spinal tuberculosis (Pott’s disease), which of the following vertebral structures is least likely to be involved?
A) Body
B) Lamina
C) Spinous process
D) Pedicle
A 40-year-old man presents with chronic mid-back pain, weight loss and low-grade fever. MRI of the spine shows destruction of the endplates of T10 and T11 vertebral bodies, along with collapse of the intervening disc. Which of the following is the most common pattern of vertebral involvement seen in Pott’s spine?
central
anterior
paradiscal
appendiceal
A 42-year-old manual labourer presents with chronic back pain, low-grade fever, and weight loss. On examination, there is a localised paraspinal spasm and an extensor plantar response. MRI is planned to evaluate possible spinal tuberculosis. Which of the following spinal regions is most commonly involved in such cases?
A) Thoracolumbar
B) Sacral
C) Cervical
D) Lumbosacral
A 38-year-old male presents with a history of spinal tuberculosis. He has completed antitubercular therapy. On follow-up radiographs, there is evidence of vertebral body fusion and loss of disc space. What are the most common sequelae of tuberculous spondylitis?
A) Fibrous ankylosis
B) Bony Ankylosis
C) Pathological dislocation
D) Chronic osteomyelitis
A 7-year-old child comes with fever and tibial swelling, on X-ray exhibiting periosteal reaction. Laboratory results show raised ESR and TLC. What is the next step in the diagnosis of the patient?
MRI
pus culture
bone biopsy
blood culture
What is the most common location of Brodie’s abscess?
A) Distal end of the ulna
B) Femoral metaphysis
C) Tibial metaphysis
D) Distal end of radius
Felon means infection of:
A) Epinychium
B)Terminal pulp space
C)Deep Palmar abscess
D)Subcuticar space abscess
A 14-year-old boy is brought to the dental clinic by his parents with a complaint of painless swelling along the lower jaw. The swelling has been gradually increasing for several weeks. There is no history of fever, trauma, or recent dental procedure. On examination, hard swelling is noticed along the inferior border of the mandible. Radiographs reveal a layered periosteal reaction resembling an onion-skin pattern. What is the most likely diagnosis?
A) Ewing’s sarcoma
B) Chronic suppurative osteomyelitis
C) Garre’s sclerosing osteomyelitis
D) Fibrous dysplasia
Which of the following is not a known complication of chronic osteomyelitis?
A) Acute exacerbations
B) Squamous cell carcinoma
C) Osteosarcoma
D) Amyloidosis
Which of the following regarding Negative pressure wound therapy is false?
A) Contraindicated in osteomyelitis
B) Pressure is 50–125 mmHg
C) Decreases bacterial load
D) Can be used continuously or intermittently
A 45-year-old diabetic male presents with persistent pain and swelling in his right leg, 2 months after undergoing external fixation for an open tibial fracture. He now reports continuous purulent discharge from the surgical site, low-grade fever and generalised fatigue. Examination reveals a draining sinus over the midshaft of the tibia and surrounding induration. Investigations reveal elevated ESR and CRP. X-ray of the leg shows periosteal reaction and cortical lucencies suggestive of chronic osteomyelitis.Which of the following is the most common cause of a non-healing sinus in this patient?
multiple surgeries
diabetes
resistant organism
sequestrum
A 4-year-old child presents with high-grade fever, right hip pain and decreased appetite for 3 days. O/E she has fullness in Scarpa’s triangle, hip is flexed, abducted and externally rotated and absent movements in the hip.What is the diagnosis
septic arthritis
acute osteomyelitis
transient synovitis
anterior dislocation of hip
All are part of the Kanavel Cardinal signs of flexor tenosynovitis except
A) Pain on palpation of the flexor tendon
B) Pain on passive stretching of the finger
C) Fusiform swelling of the finger
D) Increase in capillary refill time
All of the following are used in the treatment of TB spine except
middle path regime
hong kong operation
spine brace
right anterolateral decompression
Which of the following is not a cause of early onset paraplegia in TB spine
caseation
internal gibbus
abscess
granulation tissue
Most common organism causing Osteomyelitis following animal bite
S. aureus
pseudomonas
pasteurella
Eikenella
A 24-year-old male presents with chronic left hip pain and progressive difficulty in walking for 6 months. Examination reveals flexion and adduction deformity. X-ray pelvis shows destruction of the femoral head with enlargement and deepening of the acetabulum, giving a ‘pestle-in-mortar’ appearance. What is the most likely diagnosis?
A) AVN femoral head
B) Tom Smith’s arthritis
C) TB hip
D) Femoro-acetabular impingement
Which of the following statements regarding TB Hip is INCORRECT?
A) The earliest radiological sign is juxta-articular osteopenia / osteopaenia
B) Stage I (synovitis) shows apparent lengthening with flexion, abduction and external rotation deformity
C) Pestle-in-mortar deformity is seen in Stage II (Early arthritis)
D) Fibrous ankylosis represents Stage V of TB hip disease progression
Which tumour is the commonest true benign tumour of the bone?
A) Osteoid osteoma
B) Osteochondroma
C) Enchondroma
D) Osteoblastoma
Which of the following is a GCT variant?
A) Chondroblastoma
B) Aneurysmal bone cyst
C) Osteosarcoma with giant cells
D)Fibrous dysplasia
Elevated lactate dehydrogenase (LDH) level at the time of diagnosis is considered a poor prognostic marker for which of the following bone tumours
osteosarcoma
osteoid osteoma
giant cell tumor
Ewing tumor
The most frequent benign bone tumour of the hand is –
A) Enchondroma
B) Osteochondroma
C) Chondrosarcoma
D) Glomus tumour
Night pain that is dramatically relieved by NSAID is a classical hallmark of
osteoid osteoma
osteosarcoma
Ewing sarcoma
Fibrous cortical defect
In which condition is the Codman's triangle seen
Ewing sarcoma
osteosarcoma
osteoblastoma
metastasis
Which of the following is called as Codman's tumor
osteoblastoma
osteochondroma
chondroblastoma
Giant cell tumor
Which of the following bone tumors can cause pulmonary metastasis
GCT
chondroblastoma
both A and B
none
Which of the following drugs can be used in treatment of GCT of pelvis
alendronate
zolindronic acid
denosumab
tocilizumab
False regarding hemangioma of vertebrae
Polka Dot sign in CT
Corduroy sign in X ray
Usually asymptomatic
needs emergency excision
A patient is asked to hold a sheet of paper tightly between their thumb and index finger. On attempting to resist the pull of the examiner, the patient compensates with flexion of the interphalangeal joint of the thumb, as shown in the image. Which nerve is primarily being assessed with this test?
(a)
What nerve injury does the image depicts
(a)
Identify the splint shown in image
(a)
A 32-year-old man presents with numbness over the radial aspect of the forearm, thumb, and index finger. On examination, there is weakness in wrist extension due to involvement of the extensor carpi radialis longus. Which cervical nerve root is most likely involved?
(a)
The test is performed to identify which nerve injury
(a)
The most commonly used graft for tendon transfer
(a)
Which nerve has the best prognosis after sustaining an injury
(a)
A 25-year-old male presents after a road traffic accident with signs of brachial plexus injury. On examination, he has ptosis, miosis, and anhidrosis on the right side of his face. What is the most likely level of nerve root involvement?
(a)
Identify the splint
(a)
Pointing index/Benediction sign/Pope sign/Oschner clasp sign is seen in which nerve injury
(a)
Pen test evaluates function of which muscle
(a)
Book test is performed to evaluate the function of which muscle
(a)
The best clinical test for Carpal Tunnel Syndrome is
(a)
Meralgia paraesthetica is the entrapment neuropathy of which nerve
(a)
Osteomyelitis in sickle cell patients is most commonly caused by which organism
(a)
Which of the following are indicators of poor prognosis in a patient with spinal tuberculosis (Pott’s spine)?
Healed vertebral disc
Grade 4 neurological deficit
Kyphotic angle more than 60 degree
incomplete cord involvement
younger age with good nutrition
Which of the following statements is true regarding chronic osteomyelitis?
1. Reactive new bone formation occurs
2. Cloaca is an opening in the skin
3. Involucrum is dead bone that contains the infection
4. Sequestrum is hard and porous
Which of the following statements about Garré’s osteomyelitis are true
A) Upper end of tibia is the most common site
B) Sclerosing chronic non-suppurative osteomyelitis
C) Usually there is no discharging sinus
D) Spine is the most commonly affected
Which of the following are not included in the original Kocher’s criteria used to differentiate septic arthritis of the hip joint from transient synovitis of the hip joint in children?
1. Weight-bearing joint
2. Erythrocyte sedimentation rate (ESR) > 40 mm/hr
3. White blood cell (WBC) count ≥ 12,000/mm³
4. C-reactive protein (CRP) > 2.5 mg/L
Which of the following statements regarding chronic osteomyelitis is not true?
1. Sinus is the clinical hallmark of chronic osteomyelitis
2. Sequestrum is the pathological hallmark of chronic osteomyelitis, which is a live bone
3. Saucerisation is stopped before the paprika sign is visible
4. Causes pseudoparalysis in children
Mark the correct pairs
Carpal Tunnel Syndrome -Median nerve
Cubital Tunnel Syndrome -Ulnar nerve
Kiloh Nevin Syndrome -AIN
Pyriformis syndrome -Sciatic nerve
Which of the following statements regarding Carpal Tunnel Syndrome (CTS) are correct?
1. Hypothyroidism and pregnancy are common risk factors for carpal tunnel syndrome.
2.Phalen’s test and Durkan’s test are used in clinical evaluation of CTS.
3.Night-time symptoms are common and may be relieved by shaking the hand.
4.Tinel’s sign is considered the best clinical test for CTS.
5.Allen’s test is performed to evaluate severity of CTS.
Mark the correct pairs
Card test-Palmar interossei
Egawa test-Dorsal interossei
Fanning finger test-Palmar interossei
Book test-Abductor policis longus
Which of the following are osteoblast(bone forming cell) type bone tumor
enchondroma
aneurysmal bone cyst
osteoid osteoma
osteosarcoma
Malignant bone tumors
chondrosarcoma
osteosarcoma
chordoma
Admantinoma
Diaphyseal bone tumors
Ewing sarcoma
osteoid osteoma
Adamantinoma
Giant cell tumor
chondroblastoma
True about osteoid osteoma
generally affects the diaphysis of long bones
commonest bone affected is femur
radiolucent nidus in centre
pre malignant
Benign tumors
chondroma
osteochondroma
chordoma
enchondroma
statements true concerning osteoblastomas
A) Surrounding sclerosis may be minimal or absent
B) There is often a lack of nocturnal pain that is responsive to aspirin
C) Histologically, osteoblastoma is similar to osteoid osteoma
D) The lesion is usually 5 mm to 10 mm in diameter
Which of the following are considered a sign of malignant transformation within an osteochondroma?
fracture
new lucency
pain
thickened cartilage cap more than 1.5cm
